What I Love About Orthopaedics

As I come to the end of my orthopaedic training, I’m happy to have made the correct decision. For me, orthopaedics has a perfect mix of clinical work, surgical skills, medical technology and medical imaging. Here are a few of the reasons why I love orthopaedics.

The variety

Everyone has bones. Throughout my training, I’ve treated patients ranging from newborn babies with dysplastic hips to elderly patients with neck of femur fractures. There is a vast spectrum of orthopaedic disease. Degenerative diseases like arthritis; congenital limb deformities; neurological conditions such as cerebral palsy; infective processes like osteomyelitis; bone and soft tissue tumours that can be either primary or secondary; and traumatic injuries including fractures and tendon/ligament ruptures. This all essentially means orthopaedic life is never dull.

After five years of training, patients still find ways to break bones in new and inventive ways. I’ve seen car accidents, animal attacks, train injuries, bomb blasts, sporting injuries, gunshots, recreational mishaps and industrial accidents. I enjoy the challenge of determining the best way to reconstruct fractures, what implants to use and how to use them for a patient.

Orthopaedics also provides opportunities outside the hospital, such as working with sporting clubs, orthopaedic outreach, military involvement, research and teaching. Where you take it is really up to you.

The patients

Orthopaedic patients come in many varieties – elective or emergency; young or old; otherwise well or medically frail. Regardless of their orthopaedic situation, they all come because they need something done, and are grateful for your help in what can often be traumatic or painful circumstances.

The outcomes

I like a low Number Needed to Treat (NNT). It’s hard to argue with the results when you review a six-year-old girl with a bent forearm in the morning and then discharge her with a straight forearm in the afternoon!

Orthopaedics provides tangible patient outcomes over a short timeframe. This could be someone walking without a frame for the first time after a hip replacement; a teenage girl who now stands straight after her scoliosis surgery; or someone who can return to sport after their ACL reconstruction. The high rates of patient satisfaction make for a very rewarding practice.

The surgery

There is a fracture, I need to fix it. While orthopaedics often bears the brunt of many jokes – usually from our anaesthetic and physician counterparts over our use of so deemed “primitive” surgical implements like hammers and saws – the surgery is diverse, complex and rapidly changing as new technologies become available.

A typical list can have you restoring leg length and offsetting a hip replacement; testing your arthroscopy skills with a rotator cuff repair; using computer navigation to implant a knee replacement; planning osteotomies to correct deformities; and trying to figure out how you’re going to put someone’s smashed distal radius back together.

The complex nature of musculoskeletal anatomy requires the ability to think in three dimensions and translate medical imaging to the patient on the operating table.

The future

Orthopaedics continues to evolve. As technology advances, we can expect to see more robotically assisted surgery providing greater accuracy and longer lasting joint replacements. Replacement body parts will be 3D-printed, impregnated with patient specific cells to allow us to reconstruct what we previously couldn’t. Improvements in fixation devices will allow more minimally invasive surgery with less tissue damage and earlier mobilisation.

So we’re not just hammer-wielding Neanderthals?

While I accept that orthopaedics may not be for everyone – if you are considering a career in surgery I would urge you to think about orthopaedics. If you like to fix things, and want to be constantly challenged and make big differences in patients’ lives, then orthopaedics may just be for you.

Dr Michael Galvin
Orthopaedic Surgeon
Austin Hospital, Melbourne